Learning opportunities in the clinical setting (LOCS) for medical students: A novel approach

Figures & data

Table

Practice points

Early clinical experience that is student selected (LOCS) is an innovative approach to learning. LOCS are an efficient use of all available learning clinical opportunities LOCS have proven to be popular with medical students

Table 1.  Brief selected highlights of LOCS on an average week.

Monday sessions
Accidents and Emergency shop floor	Cardiac catheter lists
Full day with paramedics	Nerve conduction studies
Burns and plastics theatre Angiography	Specialist diabetic clinic
Echocardiogram	Endoscopy
Tuesday sessions
Autopsy	Neurosurgical clinic
Homeless GP clinic	Dietician clinic
Paediatric clinic	Orthopaedic theatre
Wednesday sessions
Chemical pathology	Artificial limb OPD
Fracture clinic	Speech and language therapy
Stroke clinic	Parkinson's clinic
General surgery theatre
Thursday sessions
Interventional radiology	Clinical examinations/bedside
ERCP	Teaching
Pain relieving procedures	Medical grand round
Friday sessions
Oral & maxillofacial theatre	Urology theatre
Anaesthetic procedures	Varicose vein clinic
Cardiac pacemakers	Cardiology teaching ward round

Note: Many of the above LOCS are available on most or all days of the week.

Figure 1. Analysis of LOCS booked between September 2007 and 2008 for each hospital.

Figure 2. No. of LOCS attended by year one and year two students 2007–2008.

Figure 3. LOCS Feedback rating 2008–2009.

Figure 4. Breakdown of positive comments.

Table 2. Examples of positive feedback.

Feedback examples:
Positive comments
Interactive/enthusiastic teachers (368 comments):
1	‘We did a ward round with the SpR in ITU, who was brilliant, and really made the effort to teach us’
2	‘I thought the midwife was really a fantastic teacher, very warm and approachable’
3	‘Everyone in the theatre was kind and helpful with all of my questions’
4	‘The consultant whose clinic I attended was very keen to teach me different aspects about his work and constantly asked me questions throughout the clinic’
5	‘The surgeons were very enthusiastic about teaching and I have never been so involved in a theatre LOCS’
High quality teaching (128 comments)
1	‘Afterwards the consultant took us around other patients on the ward and we got some very good teaching’
2	‘The doctor was excellent and is very good at teaching and getting students involved’
3	‘Great as a first surgery LOCS. Very well taught’
4	‘Fantastic teacher! Just a shame I didn't get to see any births’
5	‘I found the doctor to be brilliant. He explained to me all about strokes and I meet the patients and he explained the symptoms that they displayed’
Observing clinical skills (384 comments)
1	‘This was an amazing LOCS. I was privileged enough to see 3 specialities (plastics/colorectal/urology) in action, working on a complex case within the plastics setting’
2	‘I felt that this was a brilliant LOC to observe CVR history taking and examination’
3	‘I felt that this was a brilliant LOC to observe CVR history taking and examination’
4	‘This ward round was a good opportunity to observe medicine in relation to children. Not only did I see the challenges of paediatric medicine but also the rewards’
5	‘This was a very valuable LOCS as it was a chance to observe and understand the different types of medical imaging. I was able to clarify the differences between CT scans, MRIs and also understand ultrasound images’
Direct patient interaction (127 comments)
1	‘Took history from young girl who had a foot injury’
2	‘I got to practice history taking skills as well as learn how to palpate/examine a pregnant woman’
3	‘I saw a variety of cases including an elderly man who had a head injury, an elderly lady with abdominal pains and a drunk man brought in by the police. I also took my first history’
4	‘I got to do abdominal exams on the children and talk to them and their parents. Really really enjoyed it so thank you for this’
5	‘Got fully involved completing the warm up regime and the relaxation phase with all the patients. Also spent a lot of time talking to people about there cardiac problems’
Hands-on experience (63 comments)
1	‘Some excellent “hands-on” teaching from the surgeon. I helped to remove a section of the duodenum and closed up the abdomen wall. Brilliant experience’
2	‘Assisted with lumbar puncture’
3	‘During this LOCS I palpated the contractions of a lady who was a week overdue. I also inserted a catheter which was something I had never done before’
4	‘I got to assist with many anaesthetic procedures, practicing some of the skills of maintaining airways’
5	‘This time, I was allowed to bag the patient from the outset, and administer the first dosages of gaseous anaesthetic’
Relevance to course (160 comments)
1	‘This was a good chance to review the anatomy and pathology from the Alimentary module’
2	‘I went to the Orthopaedic day unit in order to compliment the musculoskeletal module. I gained an idea of the common musculoskeletal problems that people were affected by such as Tennis Elbow and dislocations’
3	‘I have recently been studying the abdomen, and therefore this helped me to conceptualise many of the features that I had been looking at during anatomy sessions and out of books’
4	‘I came away feeling that the experience had reinforced much of the anatomy that I had been learning and that I had a much better visual idea of not only anatomical structures, but also what certain conditions such as atherosclerosis and carbon deposits on the lung, actually look like’
5	‘This Loc was cardio-thoracic surgery and really interesting to watch. I had studied the anatomy during the week so it was good to point out the parts of the heart, mediastinum and lungs in a real body’
Personal enjoyment and development (100 comments)
1	‘I'd never watched an operation before, and I found it really fascinating’
2	‘What I thought was brilliant about it was how amazing the midwives were at their jobs, supportive, encouraging and really empowering the mum-to-be to listen to her body and try and do what feels natural to her. It was incredible and it was lovely to see a natural birth’
3	‘This LOC really opened my eyes to the problems of both homelessness and drug addiction’
4	‘It was amazing to see the difference in the patient before and after treatment. This was my favourite LOC thus far’
5	‘It is becoming a habit now that every LOC I attend is having the effect of making me consider my future’

Figure 5. Breakdown of negative comments.

Table 3.  Examples of negative feedback.

Feedback examples:
Negative comments
Limited activity (53 comments)
1	‘Unfortunately this LOCS was uneventful. I saw very little of medical note’
2	‘“Unfortunately we only saw a minor laparoscopic procedure”
3	‘This was an interesting LOCS, although it happened to be a little quiet for my visit’
4	‘This was my first LOC and was disappointing. There was not much to see’
5	‘I guess due to the variable nature of A&E it was on the whole a quiet morning, and so there was a lot of time spent doing very little.’
Poor quality teaching (49 comments)
1	‘This was very disappointing. I would not recommend this to anyone. The consultant seemed angry that we were there, then wandered off and we watched the back of another surgeon doing something we couldn't see from across a large room for >3 hours.’
2	‘I felt that it was not a useful experience as the doctor I was placed with was not there, and the one that I ended up following did not really speak to me’
3	‘I was left with the registrar who understandably was busy so I didn't get a lot out of this one’
4	‘It was enjoyable to be part of an admissions unit, but I felt lost at times; the unit was busy, and so there was not much time for explanation’
5	‘Once there, I was sat down in her office to wait for the Psychiatrist to arrive. Once he did, he pretty much ignored me and went straight to his notes’
Poor organisation of LOCS (28 comments)
1	‘Despite the doctor I was booked with not being on duty this day, (which lead to lots of confusion at the beginning) this was quite an interesting LOC’
2	‘The first attempt at this LOCS proved a waste of time as the nurse was not in her office and when finally tracked down had forgotten that a student would be attending’
3	‘The LOCS office had been informed there was to be a diagnosis of a new case of autism. However there was some confusion and this was not the case’
4	‘Unfortunately the consultant we were there to shadow was not available’
5	‘I arrived to find that the doctor was on annual leave’
Inappropriate timing of the session in relation to course (22 comments)
1	‘Knee Clinic - Would have been much more useful if had been after subject were covered in lectures’
2	‘Was a little lost at the procedures involved as knowledge of anatomy was not the best at that point but it made sense at a later date’
3	‘I enjoyed the fact that this was an out of hours clinic but would have been better placed had I booked it during a dermatology learning week’
4	‘I would like to return to the clinic in second year when I have received lectures on HIV’
5	‘Would probably have found it more useful later in the first year or second year, having covered more anatomy’